Provider Demographics
NPI:1235174871
Name:PALMETTO HEALTH CARE CORP
Entity Type:Organization
Organization Name:PALMETTO HEALTH CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-282-0214
Mailing Address - Street 1:PO BOX 20617
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-0617
Mailing Address - Country:US
Mailing Address - Phone:787-282-0214
Mailing Address - Fax:
Practice Address - Street 1:COND LAS MERCEDES
Practice Address - Street 2:AVE 65 INFANTERIA LOCAL C 5
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-1942
Practice Address - Country:US
Practice Address - Phone:787-282-0214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1046900001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT